Extreme weather to add further pressure on already-struggling emergency services

This week’s coming heatwave will add “significant pressure” to ambulance services, which have all moved to the highest alert levels.

It is understood that all 10 ambulance trusts in England – including the North West Ambulance Service – stand at Resource Escalation Action Plan (REAP) level four – the highest escalation alert level for ambulance trusts.

Level four means the service is experiencing "extreme pressure".

A North West Ambulance Service spokesperson said: “As a result of the recent warm weather and increased demand, we have decided to step up to Level 4 of Resource Escalation Action Plan (REAP) – which represents ‘extreme pressure’.

“In moving to REAP Level 4, we will be maximising all available resources, increasing staffing levels in Emergency Call Centres and on the road.

“We urge the public to reserve the 999 service for emergencies only and consider if their GP, pharmacist or 111.nhs.uk could provide them with the medical help they need.”

The alert comes as the Met Office has issued its first ever Red Extreme Heat warning for the UK, and as the latest emergency department performance figures show that the NHS has recorded the third highest number of 12-hour waits on record.
 

Read more: First Red Extreme heat warning issued which covers Greater ManchesterPublished: 15 July 2022

Speaking in Parliament earlier this week, the Minister of State for Health and Social Care Maria Caulfield said bed occupancy levels are currently at winter levels of around 93% and the NHS faces “rising pressures”.

Ms Caulfield said: “The latest figures from the NHS in England show that ambulance service response time performance has improved month on month, and that ambulance hours lost are also improving month on month.

“However, we fully acknowledge the rising pressures facing the service, and there are three significant factors influencing the situation. First, bed occupancy is currently around 93%, which we would normally see during winter. Secondly, there are high rates of hospital covid admissions – whether “with covid” or “because of covid”– and that puts pressure on A&Es’ ability to admit patients. Thirdly, void beds are running at roughly 1,200, partly due to a 16% increase in the length of stays. Delayed discharges are another significant influence, but they remain flat.

“We also have record numbers of calls to the ambulance service – 100,000 more compared with May last year. There is therefore significant pressure on the system.

“We also have to be mindful of the weather in the coming days. We do have a heatwave plan for England, which was published earlier this year and we also have the hot weather plans that NHS trusts have put in place. In addition, we are providing sector-specific guidance setting out the best way to protect people who may be at risk. We are also supporting the service more widely to make sure it has the resilience it needs. We have allocated £150 million of extra funding for the ambulance service this year, and we are boosting the workforce too. The number of national 999 call handlers had risen to nearly 2,300 at the start of June, which is a considerable increase on the previous September, and we are on track to train 3,000 paramedic graduates a year nationally every year until 2024. On top of this, we have invested £50 million in NHS 111 to help give extra capacity to the service.

Wes Streeting, the Shadow Health Secretary, pointed out that the NHS is currently “going through the biggest crisis in its history, every ambulance service is on the highest level of alert, patients are forced to wait hours in pain and discomfort.”

He continued: “Every ambulance service is now on the highest level of alert, so what is the Secretary of State doing about it? The Minister talks about targeted help for ambulance services but, as I think she acknowledged, this is a crisis across the health service. 

“What are the Government doing to provide additional support to A&Es during this heatwave? These pressures are not new. Average waiting times for stroke and heart attack victims are one hour. Patients in the north-east were told to phone a friend or call a cab rather than rely on emergency services.

Speaking during the debate, Rochdale MP Sir Tony Lloyd added that residents in the borough are “especially vulnerable” thanks to the closure of the Infirmary’s A&E in 2011.

He asked: “It means people are dependent on an ambulance service that is not in crisis because of the heatwave; it has been in crisis for some considerable time. We do not need blandishments. Why does it take a crisis for the Minister to come before the House to explain what has not yet happened?”

Responding, Ms Caulfield reiterated the funding set out for NHS 111 and the ambulance services.

She added: “We are not waiting for a crisis. There will be pressures on the ambulance service and our emergency services at times. We saw that with covid and the heatwave this week will put pressure on the NHS. There will also be pressures in winter. Opposition Members may think there is some magical way to avoid pressures, but there is not. We need to provide resources and capacity to ensure that the service can meet that demand.”

President of the Royal College of Emergency Medicine, Dr Katherine Henderson has said that the pressures facing urgent and emergency care at this time of year are “staggering.”

She continued: “This data is once again another reminder of the depth of the crisis and pressures facing Urgent and Emergency care. It is staggering that in this summer month, we are still seeing huge numbers of 12-hour waits (from decision to admit to admission) and nearly the worst four-hour performance on record.

“This week all ambulance services across the country declared REAP 4, the highest critical incident level indicating extreme pressures. Currently, patients face dangerously long waits waiting for an ambulance, waiting outside an A&E in the back of an ambulance, and waiting in crowded waiting rooms in A&Es. Among staff there is huge discomfort in the quality of care being provided, it is distressing and incredibly difficult for them to deliver optimal care in these conditions and under this pressure. For patients, there is fear and frustration at the length of time they may need to wait to receive emergency care. It is an appalling situation.

“We welcome the incoming Secretary of State for Health and Social Care, Steve Barclay, to his new post. We urge him to recognise the severity of this crisis and the crumbling urgent and emergency care system and make tackling this crisis his top priority. At this time, NHS staff need to see leadership and see that there is political will to act.

“In the short-term, the Health Secretary must recognise how important it is for 12-hour data measured from time of arrival (and already collected by all NHS Trusts in England) to be published by NHS England (as promised), this will allow for transparency of data and help us see the true scale of the crisis and begin to tackle it. Secondly, good social care underpins an effective health service and a well-functioning emergency care system. It is vital that social care has adequate resources and staff, who are valued and respected. Good social care will help patients be discharged from hospital in a timely way rather than stay longer than medically necessary. The government must deliver a meaningful plan for social care, that includes a fair pay agreement that values social care workers’ vital role.

“Lastly, the Health Secretary must finally commit to publishing the fully-funded workforce plan that this government promised to deliver – this would address the huge shortfall in staff across the health service, and in turn allow the system to open more staffed beds.”

999 services should be used in emergencies only; seek advice by calling 111 or visiting https://111.nhs.uk/ if you need non-emergency health advice.